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Morita K, Murakami M, Akagi R, Nagai K. Outcomes of brachial artery transposition in hemodialysis patients. J Vasc Surg 2024; 80:855-863. [PMID: 38750943 DOI: 10.1016/j.jvs.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/28/2024] [Accepted: 05/08/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVE In hemodialysis patients with a difficult access extremity who are not suitable for an arteriovenous fistula or arteriovenous graft creation, the concept of cannulating a superficialized artery for arterial outflow in dialysis sessions has been adopted as a tertiary alternative. However, its long-term patency and complications have not been recognized widely. We report our 16-year experience with hemodialysis access creation using the brachial artery transposition (BAT) technique. METHODS This single-center retrospective study included consecutive patients who underwent BAT for hemodialysis vascular access between June 1, 2006, and December 31, 2022. The patency of the whole access circuit and the transposed brachial artery itself was evaluated independently. RESULTS In total, 193 surgical procedures were included. The success rate was 93.2%. The mean operative time was 128 minutes. The median interval from access placement to first cannulation was 21 days. The primary patency rates for BAT were 92.3%, 91.3%, 90.3%, 86.1%, and 71.9% at 1, 2, 3, 5, and 10 years, respectively. The secondary patency rates for BAT were 96.3%, 96.3%, 95.0%, 90.1%, and 74.9% at 1, 2, 3, 5, and 10 years, respectively. The primary patency rates for the whole access circuit were 61.4%, 49.2%, 45.8%, and 26.9% at 1, 2, 3, and 5 years, respectively. The secondary patency rates for the whole access circuit were 85.1%, 83.3%, 82.0%, and 68.6% at 1, 2, 3, and 5 years, respectively. The overall patient survival rates were 79.6%, 69.6%, 54.6%, 36.5%, and 13.4% at 1, 2, 3, 5 and 10 years, respectively. The abandonments of BAT were brachial artery thrombosis (n = 6), pseudoaneurysm (n = 2), aneurysmal change (n = 1), and other reasons (n = 1). The abandonments of the whole access circuit were exhaustion of venous return (n = 26), abandonment of BAT (n = 7), and other reasons (n = 2). Complications were exhaustion of venous return (n = 26), aneurysmal change (n = 12), pseudoaneurysm (n = 6), brachial artery thrombosis (n = 7), impaired wound healing (n = 19), lymphorrhea (n = 9), skin infection (n = 5), hematoma on cannulation (n = 3), and reduced peripheral blood flow (n = 2). CONCLUSIONS The patency of BAT was excellent, and that of the whole access circuit was adequate, with a few complications. BAT is an effective alternative from a long-term perspective for patients who are unsuitable for conventional hemodialysis access creation.
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Affiliation(s)
- Keisuke Morita
- Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan
| | - Masaaki Murakami
- Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan.
| | - Ryota Akagi
- Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan
| | - Kojiro Nagai
- Department of Nephrology, Shizuoka General Hospital, Shizuoka, Japan
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Ge W, Shi Y, Liu S, Bao X, Yu M, Mi L. Superficialization of dilated radial artery for vascular access: A case report. J Vasc Access 2023; 24:818-820. [PMID: 34553621 DOI: 10.1177/11297298211047090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Successful hemodialysis treatment need a well functioning vascular access (VA) allowing two cannulation sites with enough blood flow have minimum adverse events. The expectations, age of the HD population are rising as well as the lack of conventional methods due to central venous exhaustion, we have to choose some complex access, including complex or tertiary vascular access mentioned in 2018 Clinical Practice Guidelines of the European Society for Vascular Surgery (ESVS) and the option to abandon the venous circuit in instead of arterial system, including arterial-arterial graft and arterial superficialization. This article report a complicated case of AVF dysfunction, central venous stenosis due to central venous catheter and aortic dissection stent as well as lower extremity arteriosclerosis occlusion, using the simple method of superficialization of enlarged radial artery to maintain hemodialysis.
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Affiliation(s)
- Weijing Ge
- Long Hua Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yaxue Shi
- Long Hua Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Sijie Liu
- Long Hua Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xuedong Bao
- Long Hua Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Yu
- Long Hua Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lanhua Mi
- Long Hua Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
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3
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Zhang X, Tu B, Wan Z. Radial artery superficialization for hemodialysis patients with severe heart failure: A case report. Semin Dial 2023; 36:263-266. [PMID: 36737047 DOI: 10.1111/sdi.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/09/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023]
Abstract
Arteriovenous fistula (AVF) and/or arteriovenous graft (AVG) burdens cardiac load. It is a challenge to create a vascular access (VA) on a patient who suffers severe heart failure and also combines with contraindications of central vein catheter implantation. Superficialized radial artery (RA) could be an available VA as an outflow for continuous hemodialysis. A 57-year-old male had a left arm distal radiocephalic fistula for hemodialysis for 10 months. The patient showed gradual aggravation of heart failure. RA superficialization was performed under anesthesia protocols and surgery steps. Fourteen days after the surgery, the superficialized artery supplied the hemodialysis as an outflow without any uncomfortable and complications. The echocardiographies present the changes of the heart structures and functions during the whole period from the beginning of AVF formation to the 18-month follow-up RA superficialization. RA superficialization technique should be an alternative VA for continuous hemodialysis under suitable conditions.
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Affiliation(s)
- Xi Zhang
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Bo Tu
- Department of Ultrasonography, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ziming Wan
- Department of Nephrology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Matsuda H, Oka Y, Otaka N, Sakurama K, Takatsu S, Miyazaki M. Transposition of the superficial femoral artery combined with ultrasound-guided returning-venous cannulation as a last resort for vascular access in a multi-complicated hemodialysis patient. J Vasc Access 2023; 24:149-154. [PMID: 34096372 DOI: 10.1177/11297298211023288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
A superficialized artery as a blood-drawing route could be an option for vascular access (VA) in hemodialysis patients with cardiac failure, vessel damage, steal syndrome, and venous hypertension, and it could be a secondary VA option in those with repetitive vascular access troubles, routinely requiring a blood-returning venous route. The brachial artery is preferably used for superficialization due to the benefit of its appropriate diameter for cannulation, procedural ease of surgery under local anesthesia, and usable subcutaneous vein for blood-returning route in the upper limb. The superficial femoral artery (SFA) has also been reported as a candidate for arterial transposition; however, its subcutaneous transposition could have difficulties in requiring general anesthesia and securing blood-inflow-venous routes. We experienced a multi-complicated hemodialysis patient who had intractable tunneled-cuffed catheter-related bacteremia and right atrial thrombosis, low cardiac function with bilateral proximal bifurcation of the brachial artery at the axilla, and damaged cutaneous veins in the upper limb. Herein, we report a case of successful superficialization of the SFA under ultrasound-guided regional anesthesia combined with local anesthesia and intravenous sedation, which could be feasible as a blood-drawing route with ultrasound-guided ipsilateral greater saphenous vein cannulation during chronic hemodialysis. Assisted by ultrasound-guided venous cannulation in the ipsilateral lower limb, cutaneous repositioning of the SFA could be a viable and acceptable option for VA in hemodialysis patients with a multitude of complications, wherein the possibilities of VAs of arteriovenous access, arterial superficialization using vessels in the upper extremity, or artificial devices should be eliminated.
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Affiliation(s)
- Hiroaki Matsuda
- Department of Surgery, Saiwaicho Memorial Hospital, Okayama, Japan
| | - Yoshinari Oka
- Department of Surgery, Saiwaicho Memorial Hospital, Okayama, Japan
| | - Nozomu Otaka
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University of Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Kazufumi Sakurama
- Department of Dialysis Access Center, Shigei Medical Research Hospital, Okayama, Japan
| | - Shigeko Takatsu
- Department of Internal Medicine, Saiwaicho Memorial Hospital, Okayama, Japan
| | - Masashi Miyazaki
- Department of Surgery, Saiwaicho Memorial Hospital, Okayama, Japan
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5
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Inayama E, Yamada Y, Kishida M, Kitamura M, Nishino T, Ota K, Takahashi K, Shintani A, Ikenoue T. Effect of Music in Reducing Pain during Hemodialysis Access Cannulation: A Crossover Randomized Controlled Trial. Clin J Am Soc Nephrol 2022; 17:1337-1345. [PMID: 36002178 PMCID: PMC9625091 DOI: 10.2215/cjn.00360122] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/20/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Pain during cannulation for vascular access is a considerable problem for patients with kidney disease who are undergoing hemodialysis. We examined whether listening to music can reduce cannulation pain in these patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a multicenter, single-blind, crossover, randomized trial of 121 patients who reported pain during cannulation for hemodialysis. We compared participants listening to "Sonata for Two Pianos in D Major, K.448" or white noise as control while undergoing the cannulation procedure. The cannulation operator was blinded to the intervention, and the hypothesized superiority of music over white noise was concealed during explanations to the participants. The primary end point was the visual analog scale score for cannulation pain independently evaluated by participants. RESULTS The primary analysis was on the basis of the modified intention-to-treat principle. The median baseline visual analog scale pain score was 24.7 mm (interquartile range, 16.5-42.3). Median change of the visual analog scale pain score from the "no sound" to the music period was -2.7 mm (interquartile range, -9.2 to 3.6), whereas it was -0.3 mm (interquartile range, -5.8 to 4.5) from "no sound" to white noise. The visual analog scale pain score decreased when listening to music compared with white noise. (Adjusted difference of visual analog scale pain score: -12%; 95% confidence interval, -21 to -2; P=0.02.) There were no significant differences in the secondary outcomes of anxiety, BP, or stress assessed by salivary amylase (adjusted difference of visual analog scale anxiety score -8%, 95% confidence interval, -18 to 4; P=0.17). No intervention-related adverse events were reported. CONCLUSIONS Listening to music reduced cannulation pain in patients on hemodialysis, although there was no significant effect on anxiety, BP, or stress markers.
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Affiliation(s)
| | - Yosuke Yamada
- Department of Nephrology, Shinshu University School of Medicine, Nagano, Japan
| | - Masatsugu Kishida
- Division of Nephrology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Mineaki Kitamura
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Tomoya Nishino
- Department of Nephrology, Nagasaki University Hospital, Nagasaki, Japan
| | - Keiko Ota
- Center for Clinical Research and Innovation, Osaka Metropolitan University Hospital, Osaka, Japan
| | - Kanae Takahashi
- Department of Biostatistics, Hyogo College of Medicine, Hyogo, Japan
| | - Ayumi Shintani
- Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tatsuyoshi Ikenoue
- Human Health Science, Kyoto University Graduate School of Medicine, Kyoto, Japan
- Data Science and AI Innovation Research Promotion Center, Shiga University, Shiga, Japan
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6
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Sun CY, Zhong M, Song L, Chen YG, Quan ZL, Zhao LY, Cui DM, Fu X. Direct arterial puncture for hemodialysis, a neglected but simple and valuable vascular access. BMC Nephrol 2022; 23:221. [PMID: 35739470 PMCID: PMC9219229 DOI: 10.1186/s12882-022-02836-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/23/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction The purpose of this study is to present the prevalence and effects of direct arterial puncture (DAP) for hemodialysis patients, and to introduce optimal option for the vascular access (VA) in certain hemodialysis patients with poor condition of vascular or cardiac function in a compelling situation. Methods This was a cross-sectional study. Demographic characteristics and laboratory data were extracted from the health care system. Relevant DAP information was collected by a questionnaire. Case-control matching was performed to compare the hemodialysis adequacy between DAP and other VAs. Results A total of 526 patients were selected for analysis by convenience sampling, of which 38 patients relied https://www.baidu.com/link?url=eaDh8Hn-yZGJyDB0_h4zBenKd7qY1yX-KNxO-qU49gktQOGTJJg3slTjIbG095st4hRfprQIHRjfhfeGOZyH73y8tvSUCwMmvWbUhyix2ZKon DAP for hemodialysis. The main reasons using DAP for hemodialysis included the cost of arteriovenous access creation or maintenance in 19(50%) patients and the poor condition of vascular or cardiac function in 14 (39.5%) patients. Some complications of DAP occurred, such as aneurysm or pseudoaneurysm in 16(42.1%) patients, infiltration in 12 (31.6%) patients. Differences in hemodialysis adequacy were not statistically significant between DAP and other types of VA. Conclusion In conclusion, DAP can meet the need of prescription hemodialysis, yet it has several limitations. Although the patients in our study were long-term dependent on DAP for hemodialysis with various reasons, we do not recommend DAP as a long-term vascular access if better options are available. However, DAP should not be overlooked to be a supplemental VA for hemodialysis with adequate blood flow and availability for individuals with poor condition of vascular or cardiac function in a compelling situation. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02836-1.
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Affiliation(s)
- Chun-Yan Sun
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Mi Zhong
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Li Song
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Ying-Gui Chen
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,School of Nursing, Southern Medical University, Guangzhou, 510515, China
| | - Zi-Lin Quan
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Li-Yan Zhao
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Dong-Mei Cui
- Division of Nephrology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Xia Fu
- The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, 518033, China.
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7
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Soma Y, Murakami M, Nakatani E, Sato Y, Tanaka S, Mori K, Sugawara A. Brachial artery transposition versus catheters as tertiary vascular access for maintenance hemodialysis: a single-center retrospective study. Sci Rep 2022; 12:306. [PMID: 35013367 PMCID: PMC8748867 DOI: 10.1038/s41598-021-03860-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 11/26/2021] [Indexed: 12/04/2022] Open
Abstract
Some hemodialysis patients are not suitable for creation of an arteriovenous fistula (AVF) or arteriovenous graft (AVG). However, they can receive a tunneled cuffed central venous catheter (tcCVC), but this carries risks of infection and mortality. We aimed to evaluate the safety and effectiveness of brachial artery transposition (BAT) versus those of tcCVC. This retrospective study evaluated hemodialysis patients who underwent BAT or tcCVC placement because of severe heart failure, hand ischemia, central venous stenosis or occlusion, inadequate vessels for creating standard arteriovenous access, or limited life expectancy. The primary outcome was whole access circuit patency. Thirty-eight patients who underwent BAT and 25 who underwent tcCVC placement were included. One-year patency rates for the whole access circuit were 84.6% and 44.9% in the BAT and tcCVC groups, respectively. The BAT group was more likely to maintain patency (unadjusted hazard ratio: 0.17, 95% confidence interval: 0.05–0.60, p = 0.006). The two groups did not have significantly different overall survival (log-rank p = 0.146), although severe complications were less common in the BAT group (3% vs. 28%, p = 0.005). Relative to tcCVC placement, BAT is safe and effective with acceptable patency in hemodialysis patients not suitable for AVF or AVG creation.
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Affiliation(s)
- Yu Soma
- Department of Nephrology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Masaaki Murakami
- Department of Nephrology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan.
| | - Eiji Nakatani
- Division of Clinical Biostatistics, Research Support Center, Shizuoka General Hospital, Shizuoka, 420-8527, Japan.,Graduate School of Public Health, Shizuoka Graduate University of Public Health, 4-27-2 Kitaando, Aoi-ku, Shizuoka, 420-0881, Japan
| | - Yoko Sato
- Division of Clinical Biostatistics, Research Support Center, Shizuoka General Hospital, Shizuoka, 420-8527, Japan.,Graduate School of Public Health, Shizuoka Graduate University of Public Health, 4-27-2 Kitaando, Aoi-ku, Shizuoka, 420-0881, Japan
| | - Satoshi Tanaka
- Department of Nephrology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Kiyoshi Mori
- Department of Nephrology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan.,Graduate School of Public Health, Shizuoka Graduate University of Public Health, 4-27-2 Kitaando, Aoi-ku, Shizuoka, 420-0881, Japan
| | - Akira Sugawara
- Department of Nephrology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan
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8
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Sen I, Tripathi R. Dialysis associated steal syndromes. A narrative review. THE JOURNAL OF CARDIOVASCULAR SURGERY 2021; 63:146-154. [PMID: 34235901 DOI: 10.23736/s0021-9509.21.11830-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND To review contemporary concepts in the genesis of Dialysis Access Steal Syndrome (DASS) and its current management. METHODS An electronic search of literature from 1960 to 2020 in Pubmed and the Cochrane library was conducted and practice guidelines were examined. Search terms included dialysis, steal, ischemia, access and ESRD. Clinical presentation, pathophysiology, risk factors, diagnostic techniques and management outcomes of extremity ischemia following dialysis access creation were reviewed. RESULTS Symptomatic steal occurs in 4-10% of patietns after creation of hemodialysis access creation. Risk factos include brachial based fistula, diabetes, female sex, coronary heart disease, cerebrovascular disease, tobacco use, age more than 60 and hypertension. Diagnosis is mainly clinical and can be aided by non invasive testing. Correction o finflow stenosis, Distal revasulatisation with interval ligation, revision using distal inflow or other techniques are useful for fistula preservation. CONCLUSIONS Dialysis associated steal syndromes have a complex haemodynamic causation. Clinical presentation is diagnostic; however when the diagnosis is uncertain adjunctive noninvasive perfusion tests, duplex and other imaging amy be required. Management is guided by anatomic, patient and disease-related considerations.
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Affiliation(s)
- Indrani Sen
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA -
| | - Ramesh Tripathi
- Department of Surgery, School of Medicine, University of Queensland, Queensland, Australia
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9
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Multicentre Study on the Efficacy of Brachial Artery Transposition Among Haemodialysis Patients. Eur J Vasc Endovasc Surg 2021; 61:998-1006. [PMID: 33716008 DOI: 10.1016/j.ejvs.2021.01.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 12/10/2020] [Accepted: 01/19/2021] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Brachial artery transposition (BAT) is not a well known method for obtaining vascular access (VA) for maintenance haemodialysis. This study evaluated the outcomes of BAT. METHODS This multicentre retrospective cohort study included 233 consecutive patients who underwent BAT between January 2012 and December 2013. The indications were inadequate vessels for obtaining VA, severe heart failure, hand ischaemia, central vein stenosis/occlusion, or a history of catheter/graft infection. The transposed brachial artery was used only for arterial inflow and other routes were used for outflow. RESULTS BAT was successful in 227 patients, and adequate blood flow was achieved during dialysis sessions. The first successful cannulation was after a median of 18 days. BAT was performed using superficial veins as the return route in 127 patients and arteriovenous fistula (AVF) creation in 63 patients to prevent maturation failure. In 41 patients with central venous catheterisation, the transposed brachial artery was used for arterial inflow. The complications of BAT were impaired wound healing in 14 patients, including skin necrosis in two; large aneurysms in six, including a mycotic pseudo-aneurysm in one; arterial thrombosis in five; hand ischaemia in five; lymphorrhoea in four; and haematoma/bleeding in three. The transposed brachial artery was abandoned in four, three, three, and one case of arterial thrombosis/stenosis, haematoma/bleeding, skin necrosis, and large aneurysm, respectively. Access to the return routes failed in 48 cases because of vein damage caused by cannulation in 22, AVF thrombosis/stenosis in 14, catheter infection in six, and catheter occlusion in six. At two years, the primary patency rates of the transposed brachial artery and access circuit were 88% and 54%, respectively. CONCLUSION BAT is a safe and effective technique. The patency was high for the transposed brachial artery but adequate for the access circuit. BAT can be considered for patients with an unobtainable standard arteriovenous access.
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10
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Kawatani Y, Oguri A. Minimal incision superficialization of the brachial artery: a technical note. J Surg Case Rep 2020; 2020:rjaa292. [PMID: 32939242 PMCID: PMC7482959 DOI: 10.1093/jscr/rjaa292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 11/17/2022] Open
Abstract
The Japanese Society for Dialysis Therapy recommends superficialization of the brachial artery (BA) for vascular access in patients with comorbidities. We describe a novel minimal incision superficialization surgery of a BA through a single small incision. A 78-year-old male, who underwent chronic hemodialysis through an arterio-venous fistula, was transferred to our hospital for treatment of heart failure. We chose superficialization of the right BA for new vascular access. Under tumescent local analgesia, though a single 2-cm long incision, the BA was superficialized for 10-cm long. To complete procedures in the narrow and deep space, vessel branches were ligated by vascular clip and knot-less barbed suture was applied for closure of the brachial fascia beneath the BA. The hemodynamic status during the hemodialysis improved and the New York Heat Association (NYHA) classification grade improved from IV to II. This technique can be an alternative for arterio-venous fistula in patients with comorbidities.
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Affiliation(s)
- Yohei Kawatani
- Department of Cardiovascular Surgery, Takasaki Heart Hospital, Takasaki 370 0001, Japan
| | - Atsushi Oguri
- Department of Cardiology, Takasaki Heart Hospital, Takasaki 370 0001, Japan
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11
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Takashima T, Nakashima Y, Suenaga A, Yamashita Y, Nonaka Y, Fukuda M, Rikitake S, Miyazono M, Rikitake K, Ikeda Y. Brachio-brachial arteriovenous fistula combined with superficialization of the brachial artery using a short skin incision for hemodialysis. J Vasc Access 2020; 22:462-469. [PMID: 32741248 DOI: 10.1177/1129729820944081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A brachio-brachial arteriovenous fistula with superficialization of the brachial vein and superficialization of the brachial artery are useful vascular access techniques for hemodialysis patients. However, both typically require a long skin incision from the antecubital fossa toward the axillary fossa. In addition, the brachio-brachial arteriovenous fistula in particular, which is created with not a one-stage but a two-stage procedure, requires a relatively long time of 2-3 months before it can be used for hemodialysis. Furthermore, superficialization of the brachial artery usually requires nonarterialized superficial veins for blood return. In cases where patients have no adequate superficial veins for creating an arteriovenous fistula, we have adopted a one-stage operative technique to create a brachio-brachial arteriovenous fistula with superficialization of not only the brachial vein but also the brachial artery using a short skin incision. This technique of a brachio-brachial arteriovenous fistula with superficialization of the brachial artery has several advantages over traditional approaches, including a minimally invasive procedure and early use for vascular access. To our knowledge, the presently described technique and the related data have not been previously reported in the English literature. We herein report the steps of this technique and the midterm follow-up outcomes.
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Affiliation(s)
- Tsuyoshi Takashima
- Department of Nephrology, National Hospital Organization, Ureshino Medical Center, Ureshino, Japan
| | - Yui Nakashima
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Atsuhiko Suenaga
- Department of Nephrology, National Hospital Organization, Ureshino Medical Center, Ureshino, Japan
| | - Yuki Yamashita
- Department of Nephrology, National Hospital Organization, Ureshino Medical Center, Ureshino, Japan
| | - Yasunori Nonaka
- Department of Nephrology, National Hospital Organization, Ureshino Medical Center, Ureshino, Japan
| | - Makoto Fukuda
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Shuichi Rikitake
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Motoaki Miyazono
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kazuhisa Rikitake
- Department of Cardiovascular Surgery, National Hospital Organization, Ureshino Medical Center, Ureshino, Japan
| | - Yuji Ikeda
- Division of Nephrology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Japan
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12
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Horst VD, Nelson PR, Mallios A, Kempe K, Pandit V, Kim H, Jennings WC. Avoiding hemodialysis access-induced distal ischemia. J Vasc Access 2020; 22:786-794. [PMID: 32715859 DOI: 10.1177/1129729820943464] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Timely creation and maintenance of a safe and reliable vascular access is essential for hemodialysis patients with end-stage renal disease. Hemodialysis access-induced distal ischemia (HAIDI) is a recognized complication of arteriovenous fistulas and grafts that may result in serious or even devastating consequences. Avoiding such complications is clearly preferred over treatment of HAIDI once established. Proper recognition of patients at increased risk of HAIDI includes careful pre-operative evaluation of the patient's medical and surgical history along with physical examination and imaging to determine a plan for creating a functional permanent access while minimizing the risk of distal ischemia. Our aim is to review identifying characteristics of individuals at risk of HAIDI and provide recommendations regarding pre-operative assessment. Vascular access options and techniques are suggested for establishing a functional vascular access without distal ischemia for such patients.
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Affiliation(s)
- Vernon D Horst
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | - Peter R Nelson
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | | | - Kelly Kempe
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | - Viraj Pandit
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | - Hyein Kim
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | - William C Jennings
- Division of Vascular Surgery, Department of Surgery, School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
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Ali H, Elbadawy A, Saleh M. Midterm outcomes of brachial arterio-arterial prosthetic loop as permanent hemodialysis access. J Vasc Surg 2020; 72:181-187. [PMID: 31987667 DOI: 10.1016/j.jvs.2019.10.081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The objective of this study was to report the midterm outcomes of the brachial arterio-arterial prosthetic loop (AAPL) as an alternative permanent vascular access in strictly selected patients with end-stage renal disease. METHODS This single-center prospective observational study was conducted between January 2014 and June 2017 and included 89 brachial AAPL procedures. Primary, assisted primary, and secondary patency rates were calculated using Kaplan-Meier analysis. RESULTS Exhausted peripheral veins were the most common indication for brachial AAPL. Patients were followed up for a mean period of 28.7 ± 4.9 months. Nineteen grafts developed thrombosis, 13 grafts developed pseudoaneurysms, 9 grafts developed hematoma, and 6 grafts were abandoned because of infection. The primary, assisted primary, and secondary patency rates were 62% ± 5.2%, 71.2% ± 4.9%, and 89.6% ± 3.3% at 24 months, respectively. CONCLUSIONS Brachial AAPL can offer a simple, safe, and efficient alternative as a permanent hemodialysis access in a selected subset of end-stage renal disease patients, with acceptable durability and rate of complications. Because of its unique specifications, cooperation between vascular surgeons and dialysis staff is mandatory.
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Affiliation(s)
- Haitham Ali
- Vascular and Endovascular Surgery Department, Assiut University Hospitals, Assiut, Egypt.
| | - Ahmed Elbadawy
- Vascular and Endovascular Surgery Department, Assiut University Hospitals, Assiut, Egypt
| | - Mahmoud Saleh
- Vascular and Endovascular Surgery Department, Assiut University Hospitals, Assiut, Egypt
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Nakagawa K, Yamada S, Matsukuma Y, Nakano T, Mitsuiki K. Survival comparison between superficialization of the brachial artery and tunneled central venous catheter placement in hemodialysis patients with heart failure: A retrospective study. Ther Apher Dial 2019; 24:408-415. [PMID: 31730268 DOI: 10.1111/1744-9987.13457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/31/2019] [Accepted: 11/14/2019] [Indexed: 11/29/2022]
Abstract
It remains unclear which vascular access provides better survival in hemodialysis patients with heart failure, superficialization of the brachial artery (SBA), or tunneled central venous catheter (TCVC). We retrospectively followed up 60 hemodialysis patients with heart failure who underwent SBA (n = 36) or TCVC placement (n = 24). During the median 2.2-year follow-up period, 36 patients died. The median survival time was significantly longer for the SBA group than for the TCVC group (5.7 vs 1.7 years; P < .05, log-rank test). A multivariate-adjusted Cox regression analysis showed that SBA was associated with a reduced risk of all-cause death (hazard ratio [HR] 0.30; 95% confidence interval [CI] 0.14-0.65). In the cohort of propensity score-matched 15 pairs, patients with SBA experienced fewer all-cause deaths (HR 0.29; 95% CI 0.10-0.77). Our study suggests that SBA is an alternative option in hemodialysis patients with heart failure.
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Affiliation(s)
- Kaneyasu Nakagawa
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan.,Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shunsuke Yamada
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuta Matsukuma
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Toshiaki Nakano
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koji Mitsuiki
- Division of Nephrology and Dialysis Center, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
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Ouchi H, Nishi H, Nakamura M, Hirakawa Y, Tanaka T, Takeda N, Akai T, Ohashi Y, Hoshina K, Takayama T, Nangaku M. Vascular Ehlers-Danlos Syndrome Diagnosed in a Patient Initiating Hemodialysis. Kidney Int Rep 2019; 4:1646-1648. [PMID: 31891008 PMCID: PMC6933463 DOI: 10.1016/j.ekir.2019.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/30/2019] [Accepted: 07/31/2019] [Indexed: 11/08/2022] Open
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Uchino T, Nakai H, Ichihashi H, Sasaki T, Azuma N. Vascular mapping for the decision of hemodialysis access method: Case report. J Vasc Access 2018; 20:84-86. [PMID: 29562822 DOI: 10.1177/1129729817747546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Preoperative ultrasound vascular mapping was performed to determine the surgical method for two cases where standard arteriovenous fistula was not possible. In case 1, the previous arteriovenous fistula of the left arm was occluded, and arteriovenous graft of the right arm was thrombosed after frequent percutaneous transluminal angioplasty. Contrast medium was contraindicated because of allergy. Using preoperative ultrasound vascular mapping, we were able to establish the appropriate surgical method. In case 2, hemodialysis was started by catheter insertion, and then access creation was planned. This case was treated with steroids due to a bullous pemphigoid disease and there was a high risk of infection, which precluded the use of synthetic grafts. There was also the possibility of delay in healing due to malnutrition. Therefore, appropriate surgical method was tailored by using preoperative ultrasound vascular mapping. Ultrasound vascular mapping was useful for determining the surgical creation of an appropriate access for facilitating hemodialysis cannulation.
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17
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Preoperative management of arteriovenous fistula (AVF) for hemodialysis. J Vasc Access 2017; 18:451-463. [PMID: 29027182 DOI: 10.5301/jva.5000771] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2017] [Indexed: 11/20/2022] Open
Abstract
Native arteriovenous fistula (AVF) is the favorite access for hemodialysis (HD). The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) recommends its creation in most patients with renal failure. Unfortunately, intensive efforts to promote native AVF in patients with marginal vessels have increased the rate of primary fistula failure. A non-functioning fistula prompts the use of central venous catheter (CVC) that, unlike AVF, has been associated with an increased risk of morbidity and mortality among patients receiving HD. We believe that successful and timely AVF placement relies on the development of a multidisciplinary integrated preoperative program divided into five stages: (i) management of patients with advanced chronic kidney disease (CKD), (ii) management of preoperative risk factors for AVF failure, (iii) planning of native AVF, (iv) assessment of patient eligibility and (v) preoperative vascular mapping. Focusing specifically on native AVF, we review scientific evidence regarding preoperative management of this vascular access in order to favor construction of long-term functioning fistula minimizing development of severe complications.
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Matsuda H, Oka Y, Yoshida R, Katsura Y, Takeuchi H, Oyama T, Takatsu S, Miyazaki M. Arterial Access Port: A Shunt-Less Vascular Access Using a Blind-Ending Artificial Graft Anastomosed to the Brachial Artery. Ther Apher Dial 2017; 21:185-194. [DOI: 10.1111/1744-9987.12515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 10/07/2016] [Accepted: 11/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Hiroaki Matsuda
- Department of Surgery; Saiwaicho Memorial Hospital; Okayama Japan
| | - Yoshinari Oka
- Department of Surgery; Saiwaicho Memorial Hospital; Okayama Japan
| | - Ryuichi Yoshida
- Department of Gastroenterological Surgery; Okayama University of Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Yuki Katsura
- Department of Gastroenterological Surgery; Okayama University of Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Hidemi Takeuchi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism; Okayama University of Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takanori Oyama
- Department of Gastroenterological Surgery; Okayama University of Graduate School of Medicine, Dentistry and Pharmaceutical Sciences; Okayama Japan
| | - Shigeko Takatsu
- Department of Internal Medicine; Saiwaicho Memorial Hospital; Okayama Japan
| | - Masashi Miyazaki
- Department of Surgery; Saiwaicho Memorial Hospital; Okayama Japan
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Murakami M, Sakaguchi G, Mori N. Arteriovenous fistula combined with brachial artery superficialization is effective in patients with a high risk of maturation failure. J Vasc Surg 2017; 65:452-458. [DOI: 10.1016/j.jvs.2016.08.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/04/2016] [Indexed: 11/27/2022]
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Letachowicz K, Szyber P, Gołębiowski T, Kusztal M, Letachowicz W, Weyde W, Garcarek J, Klinger M. Vascular access should be tailored to the patient. Semin Vasc Surg 2016; 29:146-152. [PMID: 28779781 DOI: 10.1053/j.semvascsurg.2016.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A cornerstone of hemodialysis treatment is the creation of a functional and durable dialysis vascular access. Every patient with chronic kidney disease should have a plan of renal replacement therapy and access site protection. Factors having a crucial impact on vascular access selection include age, comorbidity, vessel quality, prognosis, dialysis urgency, and surgeon's preferences. Our medical group have reviewed these factors in our patients and, based on recently published data, developed a clinical decision tree for dialysis access in the chronic kidney disease patient. Vascular access care should be patient-centered with the aim to maximize patient survival without loss of vascular access options; and not focused only the primary patency rates of dialysis access procedures.
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Affiliation(s)
- Krzysztof Letachowicz
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
| | - Przemysław Szyber
- Department of Vascular, General and Transplantation Surgery, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Tomasz Gołębiowski
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Mariusz Kusztal
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Waldemar Letachowicz
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Wacław Weyde
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Jerzy Garcarek
- Department of Radiology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Marian Klinger
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
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